老年吉兰-巴雷综合征的临床特征及其与血糖代谢的相关性

Clinical characteristics and their relationships with glucose metabolism in elderly patients with Guil-lain-Barré syndrome

目的 分析老年吉兰-巴雷综合征(GBS)的临床特征,并探讨血糖代谢与病情严重程度及不良预后的相关性.方法 收集2004年1月至2017年2月本院收治的GBS患者79例.根据年龄将入组患者分为老年组(年龄≥60岁)和非老年组(年龄<60岁).比较两组患者的人口学资料、前驱事件类型、首发症状、颅神经受累类型、高峰和出院时的英国医学研究理事会(MRC)评分和Hughes评分、亚型分布、血钠和血糖等实验室指标.结果 老年组中眼肌麻痹的发生率低于非老年组(6.4％vs 27.0％,P=0.02),面神经麻痹的发生率也低于非老年组(18.8％vs 45.8％,P=0.016).老年组病情高峰时MRC评分低于非老年组(32 vs 44,P=0.020),重症比例高于非老年组(80.6％vs 47.9％,P=0.004).两组间GBS亚型分布差异无统计学意义(P=0.691).老年组出院时预后不良的比率高于非老年组(67.7％vs 29.2％,P=0.001).高血糖不是重症GBS(OR=0.531,P=0.321)和短期预后不良(OR=0.519,P=0.261)的预测因素.结论 与非老年患者相比,老年GBS患者重症比例更高、疾病高峰时肌力评分更低、短期预后不良比例更高、眼肌麻痹及面神经麻痹发生更少、高血糖比例更高;但高血糖并不是重症GBS和短期不良预后的预测因素.

Objective To determine the clinical characteristics in elderly patients with Guillain-Barré syndrome ( GBS) and explore the relationship between glucose metabolism and severity and prognosis of disease. Methods Records of patients with GBS admitted between January 2004 and February 2017 from Affiliated Hospital of Jiangsu University were evaluated, including antecedent infection, initial symp-toms, cranial nerve palsy, subgroup analysis, Hughes score and Medical Research Council ( MRC) score at nadir and when discharged. Results The incidence of ocular palsy (6. 4％ vs 27. 0％, P=0. 02) and of facial palsy (18. 8％ vs 45. 8％, P =0. 016 ) were both lower in older group, compared to non-elderly group. MRC score at nadir (32 vs 44, P=0. 020), rate of severe type (80. 6％ vs 47. 9％, P=0. 004) and rate of poor prognosis when discharged (67. 7％ vs 29. 2％,P=0. 001) in elderly group were higher than non-elderly group. As to the distribution of subtype in these two groups, no significant difference was found (P=0. 691). Hyperglycemia wasn't prognostic factor of severe type (OR =0. 531,P =0. 321) or poor short-term prognosis (OR=0. 519,P=0. 261). Conclusions The clinical characteristics of elderly patients with GBS are distinct from non-elderly patients. Hyperglycemia wasn 't predictor of severe type or poor short-term prognosis of GBS.